Ahlquist Seth, Chen Kevin Y, Chang Eric, Nelson Scott D, Bernthal Nicholas M, Wessel Lauren E
Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA.
J Hand Surg Glob Online. 2024 May 18;6(4):558-562. doi: 10.1016/j.jhsg.2024.04.010. eCollection 2024 Jul.
Unplanned excisions are defined as excisions of malignant tumors performed without preoperative cross-sectional imaging or diagnostic biopsy, frequently resulting in residual disease and re-excision secondary to positive surgical margins. The purpose of this study was to compare the relative morbidity of planned versus unplanned upper-extremity sarcoma excisions.
A single tertiary referral hospital pathology database was queried from January 2015 through 2022 for primary upper-extremity sarcomas (forearm, wrist, hand, and finger). Demographics, tumor features, survival characteristics, and outcomes were retrospectively reviewed.
Forty-two upper-extremity sarcoma patients were identified, two-thirds of whom had unplanned excisions. Those with unplanned excisions were more likely to be female (relative risk [RR]: 1.9; = .002), undergo initial excision at a nonsarcoma center (RR: 14.0; < .001), have masses distal to the forearm (RR: 1.6; = .02), and have smaller masses (4.8 vs 7.4 cm, = .03). 71.4% of tumors were high grade, and 60.7% less than 5 cm in size.Unplanned excisions had positive margins in 96.4% of cases and were more likely to undergo re-excision (odds ratio [OR]: 20.0; = .001), more total resections (2.7 vs 1.4, = .009), sacrifice of neurovascular structures (OR: 6.1; = .04), adjuvant radiation therapy (OR: 4.5; = .05), adjuvant systemic therapy (OR: 10.9; = .03), or experience a complication (OR: 17.6; = .002) at an average of 38.0 months of follow-up.Nearly half of all unplanned excision patients developed a local recurrence or metastatic disease. Six patients required an amputation versus one in the planned cohort ( = .17), and 26.5% of patients died at an average of 32.5 months from presentation.
Distal upper-extremity sarcoma excisions are frequently unplanned, with high rates of morbidity compared with planned excisions. Surgeons should have a low threshold for cross-sectional imaging and core needle biopsy of atypical lesions, irrespective of size, with referral to a sarcoma center.
TYPE OF STUDY/LEVEL OF EVIDENCE: Prognostic IV.
非计划性切除被定义为在没有术前横断面成像或诊断性活检的情况下对恶性肿瘤进行的切除，这常常导致残留疾病以及因手术切缘阳性而需再次切除。本研究的目的是比较计划性与非计划性上肢肉瘤切除的相对发病率。
查询了一家三级转诊医院2015年1月至2022年的病理数据库，以获取原发性上肢肉瘤（前臂、腕部、手部和手指）的相关信息。对人口统计学、肿瘤特征、生存特征和结果进行了回顾性分析。
共确定了42例上肢肉瘤患者，其中三分之二接受了非计划性切除。接受非计划性切除的患者更可能为女性（相对风险[RR]：1.9；P = 0.002），在非肉瘤中心接受初次切除（RR：14.0；P < 0.001），肿块位于前臂远端（RR：1.6；P = 0.02），且肿块较小（4.8 vs 7.4 cm，P = 0.03）。71.4%的肿瘤为高级别，60.7%的肿瘤大小小于5 cm。非计划性切除的病例中96.4%切缘阳性，更可能接受再次切除（比值比[OR]：20.0；P = 0.001），总的切除次数更多（2.7 vs 1.4，P = 0.009），更可能牺牲神经血管结构（OR：6.1；P = 0.04），接受辅助放疗（OR：4.5；P = 0.05），接受辅助全身治疗（OR：10.9；P = 0.03），或在平均38.0个月的随访中出现并发症（OR：17.6；P = 0.002）。几乎一半的非计划性切除患者发生了局部复发或转移性疾病。6例患者需要截肢，而计划性队列中有1例（P = 0.17），26.5%的患者在平均就诊32.5个月后死亡。
上肢远端肉瘤切除常常是非计划性的，与计划性切除相比发病率较高。对于非典型病变，无论大小，外科医生都应降低对横断面成像和粗针活检的阈值，并转诊至肉瘤中心。
研究类型/证据水平：预后性IV级。
